Sundhedsaftalen som koordinationsinstrument i tværsektorielt samarbejde

Abstract

The healthcare agreements between the regions and municipalities in Denmark have been in place since 2007, during which no studies of the agreements and their development has been conducted. This thesis therefore examines how the management of the healthcare agreements has developed since 2007 and until 2019. The ambition is to deduce what influence the management has had on the chosen organisation and format for the health agreement in the northern region of Denmark (Region Nord). The thesis’ empirical data is based on interviews with administrative and political informants from Region Nord and Thisted Municipality. The interviews are supplemented with a two-part document analysis. The first part examines how the governance form has evolved since 2007, which is done by comparing the Danish health authority's initial guidance, with the current guidance on the healthcare agreement. The second part analyses how the organization, format and follow up have changed through the different generation of health agreements. The analysis illustrated how the Danish Health Authority initially operated with a very strict management of both the content and the format of the Healthcare Agreements between the regions and municipalities. This resulted in agreements that reduced the flexibility of how it could be implemented and thereby stifled innovation in the healthcare sector. The Danish Health Authority's strict management has been decreasing since 2015, to the point of no longer having any mandatory; focus-areas, format, or content. Initially, there was a looser framework for the follow-up and evaluation of the agreements, however today the objectives have shifted to primarily concern the impact and the quality. The analysis concluded that a “political steering group” for each municipality was established at the political level from the beginning. This changed with the third generation, when the “Municipal cluster structure” was adopted. This led to the establishment of four “political embedded groups” in line with the “cluster structure”. The organizational changes continue during the upcoming Healthcare Agreement, where a cross-sectoral political forum called "Health Policy Session" will be established. On the composition of the different forums, it should be emphasized that an increased participation from clinical personnel, could optimize cooperation in certain situations. The composition of forums should therefore be considered during the upcoming Healthcare Agreement, as Region Nord gets more time and freedom to create its own framework and initiatives for healthcare in Region Nord.

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A master thesis from Aalborg University

Sundhedsaftalen som koordinationsinstrument i tværsektorielt samarbejde

[The Healthcare agreement as coordination instrument in cross-sectoral cooperation]